Gastroesophageal Reflux Disease (GERD) Treatment

Gastroesophageal Reflux Disease (GERD) is among the esophageal problems treated by the experts at Robert Wood Johnson University Hospital. Gastroesophageal reflux is used to describe the backflow of acid from the stomach into the swallowing tube or esophagus. Although medical management is often successful in controlling symptoms, some individuals may be candidates for surgical correction of the reflux disorder. The University Thoracic Surgeons utilize minimally-invasive and video-assisted surgical approaches to achieve long-term success and freedom from reflux disease.

About 40% of the adult population in the United States suffer from symptoms of heartburn at least once a month. For most, it is an occasional problem which is easily relieved with over the counter medications. For others, it is a daily occurrence which adversely affects their quality of life. About 18 million people in the United States alone take medications on a chronic basis. A million of these fail to find relief.


At the lower end of the esophagus is an area of high pressure called the lower esophageal sphincter (LES). Normally, the LES serves as a one way valve, allowing food to pass into the stomach. It closes immediately after swallowing to prevent reflux. When this is defective or when it relaxes inappropriately, reflux occurs.

Some people are born with weak sphincters. Relaxation of the LES can occur due to many reasons such as certain medications, coffee, alcohol, smoking, spicy foods, chocolate and peppermint. Being overweight can also cause or worsen reflux. Certain positions such as lying down or vigorous exercise may make it worse.


Heartburn is a symptom of GERD. With GERD, stomach acids reflux upward into the esophagus. These acids cause a burning sensation in the upper abdomen and in the chest, just behind the breastbone. Some patients may also experience a sour taste in the mouth due to regurgitation. Some may have a chronic cough or wheezing due to aspiration into the airways. If reflux is allowed to occur over a long period of time, the acid causes changes to occur in the lining of the esophagus. This can lead to esophagitis, or worse, Barrett’s esophagus. Barrett’s esophagus can be a precursor to esophageal cancer.


GERD is diagnosed with any combination of the following exams, tests, and procedures:

  • Upper gastrointestinal X-ray studies
  • Esophagoscopy which is an examination of the esophagus through a flexible viewing tube
  • Pressure measurements of the lower esophageal sphincter, called manometry
  • Esophageal pH tests for acidity
  • Esophageal acid infusion test, called the Bernstein test
  • Microscopic examination of a tissue specimen, called a biopsy (especially used to detect Barrett’s esophagus)

Treatment / Surgery

Treatment for this condition usually goes in three stages.

  • The first step is to try dietary changes and lifestyle modifications. Patients should try to change the way they eat and attempt to quit smoking and drinking alcohol. Over the counter antacids may also be tried. The majority of patients will benefit from these strategies.
  • If this should prove ineffective, the next step is to add long term medications. These reduce or stop acid production in the stomach, thus relieving symptoms.
  • Those patients that do not improve with lifestyle changes, dietary modification and long term medications are referred for surgical evaluation.

Surgery to prevent reflux involves creation of a "valve" at the junction of the esophagus and the stomach, which prevents stomach acids from going upward into the esophagus. The traditional operation involved a large incision in the belly and a long hospital stay of 6 to 8 days. Nowadays, this operation can be done with laparoscopic techniques, utilizing 5 tiny incisions on the belly. This has the advantage of less pain and a quicker recovery. However, since the procedure performed on the inside is exactly the same as the traditional one, the results expected are as good. It is, however, important to realize that the laparoscopic approach may not be appropriate for some patients. Your surgeon, in consultation with your personal physician, can determine if the laparoscopic approach is right for you.

Advantages of Laparoscopic Nissen Fundoplication

Laparoscopic Traditional
Hospital Stay 2 – 3 days 6 – 8 days
Return to work 5 – 7 days 6 weeks
Cosmesis Good Poor
Pain Minimal Significant

Who Is a Candidate for Surgical Treatment?

Fundoplication can be offered to:

  • Any patient with moderate to severe symptoms of GERD, who wants to avoid a life time on medications
  • Any patient who continues to have symptoms in spite of maximal medical therapy
  • Any patient with an associated paraesophageal hernia